Exercise can be nearly as effective as therapy for depression

This is a finding that keeps coming up, and I've certainly found it true in my life, but there's a significant chicken-and-egg problem in that depression frequently precludes the motivation to exercise, and if you don't already have a deeply-disciplined routine to overcome the lack of motivation, people won't do it.

Exhortation to develop those good habits in the good times, I suppose.

This is only talking about therapy and not medication. The original study is a bit light on details https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...

> For the 57 trials (2189 participants) comparing exercise with no treatment or a control intervention, the pooled SMD for depressive symptoms at the end of treatment was −0.67 (95% confidence interval (CI) −0.82 to −0.52; low‐certainty evidence), showing that exercise may result in a reduction in depressive symptoms. When we included only the seven trials (447 participants) with adequate allocation concealment, intention‐to‐treat analysis and blinded outcome assessment, the pooled SMD was smaller (SMD −0.46, 95% CI −0.88 to −0.04). Pooled data from the nine trials (405 participants) with long‐term follow‐up provided very uncertain evidence about the effect of exercise on depressive symptoms (SMD −0.53, 95% CI −1.11 to 0.06; very low certainty evidence).

Like, what does -0.67 really mean in this context. I read the study and it is not really explained. Maybe I'm too dumb to get it, though.

Exercise is great, just make sure to take sometime to evaluate where you are at mentally. I was running about 40 miles and doing 5 hours of lifting per week to try and stay a head of my depression, and when I finally burnt out everything came crashing down all at once.

I think one of the tricky things about depression is how unique each person's experience with it can be. I can only speak from my own history. For me, medication was indispensable in getting me to a point where lifestyle changes could occur.

That being said, I do believe that exercising, eating right, maintaining a healthy sleep schedule, etc., all the boring lifestyle things have been key to preventing myself from slipping back into that depressed state, years after stopping medication.

If it helps anyone I take antidepressants and have had a positive experience with them. Depression can be caused by a chemical imbalance and no amount of exercise or talking about it will fix it.

One of the most frustrating things when your really low is people giving advice like do exercise to feel better - please don’t do this.

I can see how therapy can be helpful for some people. But I find it to be a big scam from my own personal experience.

What incentive do they have to give you immediate and durable results? Why do most only take cash?

I did some ML work with an addiction psychiatrist at the peak of the opioid crisis. He said,”To pay my bills, I have to treat rich people.”

I find taking long walks and speaking candidly about how I’m feeling is always the most effective way to deal with tough emotions.

I take this to mean therapy for depression (particularly for men) is barely effective at all and exercise is not quite as barely effective at all.

If therapy for depression were a pill, I'm not sure it'd demonstrate enough efficacy to get approved.

I took meds for depression a few years ago. I don't know that they did anything other than signal to myself that I wasn't ready to give up. They may have served as a kind of "dumbo's feather" that helped me get through a rough patch. Exercise might be similar. People who choose to exercise make the statement to themselves that they are worth doing something positive for. Some mental health problems resolve with time and without medication, and in those cases, exercise might be a great way to address them. But if you're struggling, call your doctor and make and appointment. Medication is sometimes the answer.

There is a tri-lateral(?) relationship between exercise, sleep, diet, and how the three impact mental health.

A waste product of exercise is Adenosine. Adenosine build-up leads to increased sleep pressure, and improved Neural Function of Sleep, not just "being unconscious".

This is where things get a bit interesting when we look at depression. For many people, depression results in decreased Neural Function of Sleep (specifically slow-wave activity) even though sleep time often increases.

However there is also some evidence that restricting slow-wave activity can act as a "reset" button. The researchers I have spoken to about this are either in the "too dangerous to do the research" camp, or "distrupting slow-waves for a very short period, then increase slow-wave activity".

Of course, sleep and exercise would only be a single pathway to improving depression outcomes. Exercise alone, and the dopamine, oxygenation, and many other outcomes are also likely to come into play.

Comparing this to pharmaceutical or behavioural therapies, I can see why they'd be as effective. You're treating the entire system, not just trying to change a single chemical in the brain, specifically when we aren't even measuring the chemical before or after treatment.

I decided to go unmedicated from SSRIs/mood stabilizers in 2024 and it changed my life for the better. Prior to stopping, I thought I was physically unhealthy until I found out excessive overheating & exhaustion was a common side effect of Zoloft. Since then, I've lost around 40 pounds and have been able to regularly exercise without issues. My mental health also improved with forcing myself to get vitamin D outside. It can be the simplest of things to improve your life, but it can be easy to forget (especially WFH).

Physical exercise, like diet, and mood are complicated bio-psycho-social functions that are depended on dozens of overlapping factors in each person. Most meta-analyses and their underlying studies ignore most of these dimensions and come to a binary yes-no conclusion based on a mere p-value. Huge confounding effects persist that the studies should heavily take into account. At least examining such popular functions provide large samples cheaply.

I've found out that running outside just for 10 minutes with quite high intensity is really effective for anxiety / depression with instant effect. Also, specifically lactic acid producing exercises, such as doing free squats quickly works too. It might have something to do with how the brain uses lactic acid for some functions, but this is just my guess.

Found out that there's some research on this: https://www.biotechniques.com/biochemistry/exercise-lactate-...

I've had many exercise regimens throughout my life but never has it ever helped me with mental health in any way.

Exercise has always been a mental drain for me. A day when I go to the gym is a day when I give up mental capacity that could have been used for something else. I'll be less effective at work and less organized at home. It's like my IQ's dropped by double digits.

I drink enough water and electrolytes, in case anybody's wondering.

This kind of makes sense. Most forms of depression have to do with not wanting to do something or lacking motivation to do so. Whereas in sports, people get busy usually, they do something, even if it may just be soccer playing. Exercise is also usually good for one's physical well-being, blood circulation increases, muscles may improve, pain may go away (depends on the exercise, but usually say, two days after some heavy work out, most people may feel better than before, unless it was some extreme exercise that caused injury).

I don't think this works for all type of depression though.

I tried intensive workout

It's unhelpful because I got tired, and then I stopped workout entirely

Now I just do fast walking and it's nice

I will speak from my experience. I have diabetes and I try to manage it well, with workout. But sometimes when the sugars are high for a while, I can feel it, the sadness, the hopelessness. It took me a while to understand that is high sugar levels and a mild form of depression. Now I will do some workout when I feel that and after a little workout, I can see how my mind also start to feel better. This is not a solution for everyone who is experiencing depression probably but might help some who are experiencing because of high sugar levels.

I would assume that "doing something" is the key here? Successfully doing exercise probably has add on benefits that you can more successfully do other things afterward. But successfully reading a book can help me get out of depression. Successfully cleaning the kitchen. Really, just successfully doing anything is a huge cure against depression.

I'm sure the result is in some sense valid, but it's like saying that radiation therapy can be nearly as effective as antibiotics for a sore throat. The conditions under which it works, the method of action, and what is accomplished are all different.

This leads to a fairly obvious conjecture :

That since for 100,000 years humans were roaming the landscape gathering or hunting, and for 10,000 years engaged in heavy agricultural work, is the modern day rise in depression not just correlated but caused by the modern day reduction in daily heavy exercise?

It’s such an obvious idea I am wondering if folks know of any research / studies on it?

The audiobook Spark by Dr. John Ratey, psychiatrist is a great listen with a bunch more evidence based arguments to support that exercise is better then drugs for depression.

I highly recommend the audiobook as it is read by him and he is very enthusiastic about his research.

The one quote I remember from the book is that he stopped prescribing Prozac and started prescribing treadmills...

It’s also fantastic for anxiety, or at least it has been for me. Though I’ve heard anxiety and depression are often linked so I wonder if there’s some common underlying mechanism by which it helps either both.

Therapy carries a huge risk, so maybe if you compare average outcomes exercise is only nearly as effective, but if you consider the 2 overall exercise comes out way, way ahead imho.

I exercised for years. I’m talking multiple hours a day. It was a part time job. It never improved my mood.

Some people don’t suffer from chemical imbalances, unhealthy habits ruining their mood, or whatever your snake oil will magically cure. There’s a term called Shit Life Syndrome and some people just have that as their long term situation.

Unfortunately, if exercise is only nearly as effective as therapy for depression, it may mean that the benefits of exercise are not actually really clinically observable, if measured properly and not just based on arbitrary statistical significance.

Standardized effect sizes like the ones reported here have no clinical meaning, they are purely statistical. To measure if these kinds of changes matter, you need to determine the Minimal (Clinically) Important Difference [1-2]. I.e. can clinicians (or patients) even notice the observed statistical difference.

In practice, this is a change of about 3-5 points on most 20+ item rating scales, or a relative reduction of 20-30% of the total (sum) score of the scale [1-2]. Unfortunately, anti-depressants are under or just barely reach this threshold [3-4], and so should be widely to be considered ineffective or only borderline effective, on average. Of course this is complicated by the fact that some people get worse on these treatments, and some people experience dramatic improvements, but, still, the point is, depression is extremely hard to treat.

EDIT: There is less data on MCIDs for therapy, but at least one review suggests therapy effects can be in the 10+ point range [5]. But the way the exercise study is presented, with a standardized effect size, we can have no idea if the results matter at all [6].

[1] Button, et al. (2015). Minimal clinically important difference on the Beck Depression Inventory - II according to the patient’s perspective. Psychological Medicine, 45(15), 3269–3279. https://doi.org/10.1017/S0033291715001270 [https://www.cambridge.org/core/journals/psychological-medici...]

[2] Masson, S. C., & Tejani, A. M. (2013). Minimum clinically important differences identified for commonly used depression rating scales. Journal of clinical epidemiology, 66(7), 805-807. [https://www.jclinepi.com/article/S0895-4356(13)00056-5/fullt...]

[3] Hengartner, M. P., & Plöderl, M. (2022). Estimates of the minimal important difference to evaluate the clinical significance of antidepressants in the acute treatment of moderate-to-severe depression. BMJ Evidence-Based Medicine, 27(2), 69-73. https://doi.org/10.1136/bmjebm-2020-111600 [https://ebm.bmj.com/content/27/2/69.abstract]

[4] Jakobsen, J. C., Gluud, C., & Kirsch, I. (2020). Should antidepressants be used for major depressive disorder?. BMJ evidence-based medicine, 25(4), 130-130. https://doi.org/10.1136/bmjebm-2019-111238 [https://ebm.bmj.com/content/25/4/130.abstract]

[5] Cuijpers, P., Karyotaki, E., Weitz, E., Andersson, G., Hollon, S. D., & van Straten, A. (2014). The effects of psychotherapies for major depression in adults on remission, recovery and improvement: a meta-analysis. Journal of affective disorders, 159, 118–126. https://doi.org/10.1016/j.jad.2014.02.026 [https://pubmed.ncbi.nlm.nih.gov/24679399/]

[6] Pogrow, S. (2019). How Effect Size (Practical Significance) Misleads Clinical Practice: The Case for Switching to Practical Benefit to Assess Applied Research Findings. The American Statistician, 73(sup1), 223–234. https://doi.org/10.1080/00031305.2018.1549101

I found this to be contradictory with my mental health period even after losing nearly 100 pounds, and going from zero to walking 8 to 10 miles a day, my mental health did not improve. It felt good to accomplish goals, two life-changing goals, really, but my overall disposition and deep depression did not change. I have no explanation for this.

Extremely disappointing analysis in the article and also the cited paper's abstract [0]. The only way this data could possibly hold any value is if they found a way to control for how depression might influence an individual's likelihood of choosing to participate in the trial in the first place, as well as trial completion rates.

Even an amateur could read the headline and instantly understand this critical point the experiment's design, and yet it's not even acknowledged under the "Risk of bias" section.

[0] https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...

Nearly as effective? It’s significantly more effective!

Everyone already knows this except nerds who spend their life on HN doing nothing ;^)

I’m here ti add my own anecdotal two cents:

2024 has been a rough year. I didn’t begin any real recover until around march-may 2025… when i started going yo the gym and lifting weights. Yeah sure i’m doing therapy and all that jazz but the real improvements started with weight lifting.

It's almost as if humans were optimized to constantly move around all day by evolution. Huh. Who would have thought.

I read the title as "Exorcise". I'll show myself out.

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